Why are some doctors high-prescribers of benzodiazepines and minor opiates? A qualitative study of GPs in Norway.
BACKGROUND
Registration studies have shown great variations in prescribing volume and prescribing patterns of benzodiazepines (BZDs) and minor opiates among GPs.


OBJECTIVE
We aimed to form a basis for hypotheses and build theories about prescribing, in order to investigate how high-prescribing doctors can legitimize their own prescribing pattern.


METHODS
A qualitative interview study of doctors with previously known high, medium and low prescribing volumes was performed. The interpretation focused on the doctors' self-explanations and how they influence their daily decision of prescribing.


CONCLUSIONS
It was a striking feature that many of the attitudes towards the drugs were common both within and between the three groups of prescribers. All doctors regarded the task of prescribing as difficult, and the great majority strongly advocated restriction in prescribing. In order to cope with daily practice and to live with high prescribing volumes, doctors make use of effective working strategies. These strategies, of ascribing responsibility to the previous doctor, to patient autonomy and responsibility, to the patient's age and to concomitant diseases, are described in this study. An allocation of responsibility to other persons or circumstances delimits the doctors' professional discretion in this matter. Striking differences between prescriber groups were not found in the analysis, but when all small tendencies in all steps of the decision-making process were added, a clear trend was revealed.
Dybwad
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TB
Seksjon for allmennmedisin, Institutt for allmennmedisin og samfunnsmedisinske fag, Oslo, Norway.
Kjølsrød
L
L
Eskerud
J
J
Laerum
E
E
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004992:Ethics, Medical; D005194:Family Practice; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D009664:Norway; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012941:Social Responsibility
D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D009294:Narcotics; D001569:Benzodiazepines